Individual provider Active NPI

Diana O'Reilly, PA-C

  • Surgical Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1871009795
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA14895 Issued in TX
Practice address
1325 Pennsylvania Ave Ste 680
Fort Worth, TX 76104-2133
Phone
(817) 250-4235
NPI assigned
Dec 15, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA14895 TX Primary

Addresses

Primary practice location

1325 Pennsylvania Ave Ste 680
Fort Worth, TX 76104-2133

Mailing address

1325 Pennsylvania Ave Ste 680
Fort Worth, TX 76104-2133
Phone (817) 250-4235

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180825000129 AL Practitioner - Physician Assistant 1052660990 Reassigns benefits to 1 organization
I20211012001751 TX Practitioner - Physician Assistant 1052660990 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Oct 1, 2021 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

1325 Pennsylvania Ave
Ste 680
Ft Worth, TX 76104
Phone (817) 250-4235

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1871009795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 PENNSYLVANIA AVE STE 680",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042133",
            "telephone_number": "817-250-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 PENNSYLVANIA AVE STE 680",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042133",
            "telephone_number": "817-250-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'REILLY",
        "first_name": "DIANA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-15",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA14895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.